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1 month old has dropped in weight percentile

My one month old has dropped from the 33rd percentile to the 22nd percentile. We've been dealing with a bad latch from birth, but I can't seem to get her to latch correctly and maintain a strong suck at the same time. My supply is plummeting at this point, and I'm extremely overwhelmed about it. I've been working with an LC, but I'm still experiencing these issues. A couple of questions: 1) When should I worry about the weight issue? 2) What can I do about the latch and plummeting supply?

Re: 1 month old has dropped in weight percentile

Nursing is definitely painful but has gotten less painful than it was in the beginning. Baby girl prefers to latch at the tip vs opening wide and getting the entire nipple. She also tends to suck very lightly although we will have parts of feedings where she'll suck harder.

What is confusing to me is that her diaper output is great....6-9 pee diapers per day and several stools.

She has been weighed on the same scale (doc's office) each time. Her birth weight was 7 lbs 6 oz. On day 3, she was 7 lbs 0.5 oz. At 1 week, she had gained her birth weight back (I was pumping and supplementing w/pumped milk b/c she would not latch at all). At 1 month (today's appt), she was 8lbs 3 oz. I did notice that the nurse weighed her w/o a diaper this time when she had her diaper on before.

I tried to pump today and only got a 1/4 oz out of both breasts after baby only nursed for about 10 minutes. When I was pumping before, I was able to get 2 oz total after a 45 minute feed. Also, she cries at the breast when she tries to feed and will tug at my nipple. My breasts also do not feel as full anymore.

Re: 1 month old has dropped in weight percentile

Painful nursing can be an indication that baby is compressing the nipple as she nurses. Compressing the nipple can be compared to crimping a hose- it slows the flow of fluid and can lead to reduced milk transfer. So the painful latch is definitely the part of your post that concerns me the most. Did the LC check the baby carefully for tongue and lip ties? They can cause difficulties with opening wide and with achieving a deep latch.

The good diaper output does paint a more positive picture than the painful nursing. Good diaper output points to the baby getting enough to eat, regardless of what the charts say about her weight. Don't worry about "only" pumping 1/4 oz after nursing. That's actually a very normal amount to pump after a feeding- some moms can't pump anything!- and when you were pumping 2 oz after nursing, that was 2 oz of extra milk. Most moms find that pump output and also their feelings of fullness decline or even vanish after they have been nursing for a while and the initial overproduction phase has passed.

Something that could be going on is a phenomenon called "catch up/catch down" growth. This is what happens when a baby follows one growth trajectory inside the womb, but a different trajectory outside the womb. A baby could be born small or average and shoot up to the top of the charts, or be born large or average and decline to a lower percentile. As long as the baby is nursing enough overall, having good diaper output, continuing to grow in all dimensions (height, weight, head circumference), and is on track developmentally, it's okay for them to vary their place on the chart.

If this were my baby, I would continue to watch her diaper output and growth carefully, and continue to work hard to improve the latch. I would also encourage her to feed as often as possible- not allowing her to sleep through the night or go more than 2-3 hours between feedings. I'd also go back to the LC, and ask what she thought about maybe doing some pumping in addition to nursing. Pumping in addition to nursing would help you create more milk, and if more milk were available your baby might have an easier time transferring it even if her latch isn't all it should be.

Re: 1 month old has dropped in weight percentile

She was checked for tongue tie and was clipped a couple of weeks ago. Her latch did improve somewhat, but we still have a lot of work to do. I've been doing tongue exercises as well as tickling her nose to get her to open wide. She seems generally happy, and she nurses a lot. It just seems like her latch is still in need of serious improvement (clicking and swallowing air, not opening wide, clamping, and many moments of very soft nursing...almost as if she couldn't possibly get any milk). I forgot to add that I also have thrush right now, so we're both being treated for that....not sure if that changes anything. I've been feeling comfortable b/c of the great diaper output. I was given the option to pump, but I nurse quite a bit.....most times during the day, I nurse her hourly for 45 minutes giving me only 15 minutes b/t feeds (calculating the sessions from the beginning time of the feed). It's very hard to find time to pump on top of nursing especially since I have a 3 year old to care for as well. Thanks for your info. It does ease my mind. She does have great diaper output, so maybe this is just her catching down.

Re: 1 month old has dropped in weight percentile

Thrush would certainly explain the latch pain.

The clicking and soft sucking, though, along with the pain and the long feedings... It makes me worry just a tad, YK? I'd want to watch her diaper output and weight gain really carefully. Maybe drop by the pediatrician every couple of weeks and get her weighed, and make sure she's on track.

Have you tried doing breast compressions to get more milk into her? How about switch nursing?

Re: 1 month old has dropped in weight percentile

Yes. I do breast compression each time. I just started switch nursing today after reading another post about it. Her diaper output is still great today....we're already on 2 stools and 4 pee diapers halfway through the day. I do nurse A LOT....I've spent most of my day today nursing. That may explain the great output.

Re: 1 month old has dropped in weight percentile

Any idea how to get baby girl to suck more efficiently? She knows how to do it b/c she will occasionally do a great extraction (typically on my right breast....her preferred breast). However, I'm having a hard time getting her to do it consistently.

Re: 1 month old has dropped in weight percentile

Thanks for all the help I did a little pumping today. After I was able to actually get a 2 hour break from nursing this afternoon, I pumped to see how much my output would be. I got 2 total ounces from both breasts. I fed her the pumped milk and let her nurse for comfort. A couple of hours later, I nursed baby girl first and pumped what she didn't extract. I got half an ounce total from both breasts. It seems like she is getting a decent amount even though she's not sucking very hard. That was somewhat reassuring!